After Sir David Nicholson's resignation, the NHS must be opened up to full
scrutiny, writes Chris Skidmore.

So Sir David Nicholson’s 30-year career in the NHS will come to an end in April 2014. A larger than life civil servant, who was once a member of the Communist party, Sir David has been a figure of huge controversy since the moment the Francis Report was published in February.

The report didn't cast blame or name "scapegoats" for the sickening neglect of care at Stafford Hospital, where Sir David had been involved as head of the local strategic health authority. But with 1,200 "excess deaths" at the hospital, many in Westminster were bound to call for his head – not least because he dismissed the whistle-blowing group "Cure the NHS" as a mere "lobbying" group.

How could accountability be exercised if no one at the higher levels of the health department would share the blame? It led to accusations of a culture of self-protection that effectively prevented NHS workers from exposing poor care.

Sir David Nicholson found himself caught up in a political vortex as he was branded the "man with no shame": apologies were never going to be enough. Yet at the same time, with the finger pointed directly at Nicholson, other massive failures at the department were seemingly overlooked. Why, for instance, was Labour's Andy Burnham able to approve Mid Staffordshire as a foundation trust – essentially a badge of excellence in the NHS – after reviewing only four lines of evidence for the case? And why were Labour ministers able to ignore 81 requests for a public inquiry into the scandal before one was eventually granted by the Coalition Government?

The message from the Francis Report was to ensure that such failures of care never came about again: making 290 recommendations, the Government set out their response in March to instigate a culture of "zero harm", and is now moving to implement a chief inspector of hospitals, as well as other patient-centred measures that intend to put care, rather than the target-driven culture of the New Labour years, at the heart of the NHS.

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For patients to have confidence in a system that their taxes pay for, there must be no excuses for failure – whether that be high mortality statistics, or poor levels of care. Hospitals that are not fit for purpose are not fit to practise, and should be either closed or allow new providers to take them over.

If the chief inspector role is to have teeth, then we should be moving to an Ofsted-style approach that will not only name and shame hospitals, but will provide the public with wide-ranging information on the performance of hospitals, and create league tables demonstrating where local provision simply isn’t good enough.

For the past 20 years we have become comfortable talking about failing schools. Everyone agrees that educational failure cannot be tolerated. Now we must be prepared to accept that there are failing hospitals too, where an equal determination to eradicate failure must be instilled.

The Care Quality Commission can approve care homes or other care settings, but there are few benchmarks for what good quality care actually looks like. The previous government abolished the "traffic light" system of setting out which providers needed improvement: it needs to be brought back with even greater insight to the practices, or malpractices, of all areas where the NHS functions, so that the torch of transparency can expose failure where it exists.

This means getting tough with the prevailing wisdom that the NHS, as a universal service, is universally superb. If we continue to uphold the NHS as a national religion, then we will be little better than the islanders on Easter Island, setting up totems and worshipping false gods to the detriment of sustaining what should be, given the £104 billion that is spent annually on health care, a first-rate service.

We should never have had to be making excuses as to why 1,200 people died unnecessarily at Mid Staffordshire. How patients came to die lying in their own excrement or, dying of thirst, were forced to drink stale water from flower vases, will forever be associated with a failed system of health care.

Systems can be altered, reinvented even, yet in the longer term if the NHS is to withstand the pressures of a rapidly ageing population at the same time as a equally rapid rise in the number of chronic conditions such as diabetes, then we will need to think again. Yes, patients need to be at the centre of their care (this much is self-evident) yet for too long politicians and policy makers have sought in vain for the holy grail of integration – joining up services so that patients, particularly elderly patients, are placed upon effective care pathways without falling through the cracks in service provision.

With NHS costs expected to spiral to £250 billion without further reform by 2050, we must tackle head on how we ensure that our elderly population gets the effective care it needs by breaking down the Chinese wall between health and social care. Personal budgets, in the longer term, could be a means of achieving this, empowering patients and reminding the professions that the NHS is not theirs alone: it belongs to the people whose taxes fund their care, and who deserve the individual choice and control for what their taxes pay for.

Chris Skidmore is MP for Kingswood and a member of the health select committee